| NPI | 1538194121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00048975) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VT 420010788) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-09-18 |